Investigating the Impacts of Area Deprivation Index in Rheumatoid Arthritis




Kim, Joseph

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BACKGROUND/PURPOSE: Rheumatoid arthritis (RA) is associated with increased morbidity and mortality, particularly if RA is poorly controlled. The effects of socioeconomic deprivation have not been well studied in the context of RA. We analyzed the impact of the Area Deprivation Index (ADI) on disease activity in RA. METHODS: We conducted a retrospective analysis of RA patients, defined by ICD-10 codes, seen at the UTSW and Parkland clinics in the past 5 years and are 18-89 years old. We collected age, ethnicity, race, gender, insurance plan, primary language, address, RA medications, MyChart engagement, primary care physician presence, ED/Inpatient visits over 5 years, RA disease activity and functional scores (RAPID3, HAQ), Charlson comorbidity index (CCI), and CVD presence. ADI was used as a proxy for socioeconomic deprivation and was assigned using 9-digit zip codes. Patients were divided by the upper ADI quartile vs lower ADI quartiles and matched by gender, race/ethnicity, age and CCI for propensity score analysis. Two-sample t test and Chi-square test were conducted for final group comparisons. RESULTS: 862 patients from UTSW and 1320 patients from Parkland were assessed in the final analysis. The median national ADI score was 45 and 72 for UTSW and Parkland respectively (range 1-100). In the UTSW cohort, those with high ADI scores (more deprived) had significantly higher RA disease activity (RAPID3: 11.9±7.1 vs 13.8±7.1, p<0.0001) and RA functional impairment (HAQ: 0.77±0.7 vs 0.94±0.7 p<0.001), were more likely to have cardiovascular disease (p<0.05), had lower MyChart utilization (p<.0001), more emergency department visits (p<0.05) and had lower jakinib use (p<.0001) compared to those with low ADI scores (less deprived). There were also statistically significant differences in insurance type (p<.05) and smoking status (p<.01). In the Parkland cohort, there were no significant differences between high ADI and low ADI groups in any of the measured variables. CONCLUSION: We found significant differences in RA disease activity and function in patients from more socioeconomically deprived areas only in the UTSW system. The absence of these differences in Parkland patients raises important questions as to whether certain hospital specific factors influence the role ADI plays in various health outcomes. Identifying the discrepancies between the two hospital systems may elucidate areas of improvement for patient care.

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The 61st Annual Medical Student Research Forum at UT Southwestern Medical Center (Tuesday, January 31, 2023, 3-6 p.m., D1.600)

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Kim, J., Xie, D., Zhang, S., & Solow, E. B. (2023, January 31). Investigating the impacts of area deprivation index in rheumatoid arthritis [Poster session]. 61st Annual Medical Student Research Forum, Dallas, Texas.

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